<form id="creation_form_container" class="form-horizontal" action="/applications/crud/index.jsp?action=create" method="post">
	<legend>
		<h1>  Creation Form</h1>
	</legend>
		
	<div class="control-group">
	    <label class="control-label" for="inputName">Name</label>
	    <div class="controls">
	      <input type="text" id="inputName" name="name" placeholder="Name">
	    </div>
  	</div>
	
	<div class="control-group">
	    <label class="control-label" for="inputName">First Name</label>
	    <div class="controls">
	      <input type="text" id="inputFirstName" name="firstname"placeholder="First Name">
	    </div>
  	</div>
  	
  	<div class="control-group">
	    <label class="control-label" for="inputEmail">Email</label>
	    <div class="controls">
	      <input type="text" id="inputEmailUser" name="email_user" placeholder="User">
	      <div class="input-prepend">
  			<span class="add-on">@</span><input class="span2" id="inputEmailDomain" name="email_domain" size="16" type="text" placeholder="Domain">
  		  </div>
	    </div>
  	</div>
  
  	<div class="control-group">
	    <label class="control-label" for="inputName">Birth Date</label>
	    <div class="controls">
	      <input type="text" id="inputMonth" name="birth_date_month" class="span1" placeholder="MM">
	      <span> / </span>	    
	      <input type="text" id="inputDay" name="birth_date_day" class="span1" placeholder="DD">
	      <span> / </span>
	      <input type="text" id="inputYear" name="birth_date_year" class="span1" placeholder="YYYY">
	    </div>
  	</div>
  	
  	<legend></legend>  	
  	<legend>Addresses</legend>  	
  	
  	<div class="container-fluid">
	  <div class="row-fluid">	  	
	    <div class="form-inline span6">
	    	<blockquote>Billing Address: </blockquote>	    		    
	    	<div>
	    		<input type="text" class="span2" name="billing_address_number" placeholder="Number">	    		
				<input type="text" class="span8" name="billing_address_street" placeholder="Street">
	    	</div>
	    	<br/>
	    	<div>
	    		<input type="text" class="span3" name="billing_address_zip_code" placeholder="Zip Code">
				<input type="text" class="span7" name="billing_address_city" placeholder="City">
	    	</div>				    
	    </div>
	    
	    <div class="form-inline span6">
	    	<blockquote>Shipping Address: </blockquote>
	    	<div>
	    		<input type="text" class="span2" name="shipping_address_number" placeholder="Number">
				<input type="text" class="span8" name="shipping_address_street" placeholder="Street">
	    	</div>
	    	<br/>
	    	<div>
	    		<input type="text" class="span3" name="shipping_address_zip_code" placeholder="Zip Code">
				<input type="text" class="span7" name="shipping_address_city" placeholder="City">
	    	</div>		  	      
	    </div>
	  </div>
	</div>
	
	<div class="form-actions">
	  <button type="submit" class="btn btn-primary offset5">Submit</button>
	  <button type="reset" class="btn ">Reset</button>
	</div>		  	 
</form>

<script src="/apps/crud/js/creation_form.js"></script>
